Dialogue between Midwives and Parents-to-Be about Alcohol, from a Life Cycle Perspective—An Intervention Study

Hjördis Högberg1*, Fredrik Spak2, Margareta Larsson1

Abstract

The objective was to investigate the use of alcohol during pregnancy among parents-to-be and to develop and evaluate a method for a dialogue about alcohol from a life cycle perspective. The study was a quasi-experiment. An intervention group (IG) with 238 couples and a comparison group (CG) with 271 couples participated. All of the participants were recruited at public antenatal care clin- ics (ANC) in Sweden. At registration, the midwife had a dialogue about alcohol with the IG, and the intervention was evaluated using questionnaires in pregnancy weeks 12 and 33. Alcohol consump- tion, alcoholism in the family, social support, and source of information were measured. More than 91% of all pregnant women reported that they never drank alcohol either at registration or late in pregnancy, with no difference between the intervention group and the comparison group. Their male partners had a different pattern; 6% abstained from alcohol and about half of them drank alcohol two to four times a month. Nine percent of the participants had experienced an alcohol-de- pendent parent and 35% of the couples reported alcoholism in either of their families. Most women (92%) stated that the partner’s support to give up alcohol was important. After the intervention, more women in the IG were offered alcohol-free alternatives. About 40% of the partners had re- duced their alcohol consumption; they received less social support for alcohol reduction than the pregnant women. A majority, 68%, of the women in the IG stated ANC as the most important source of information about alcohol and pregnancy, compared to 53% in the CG (p < 0.001). After the intervention, a higher proportion of women in the IG were offered alcohol-free alternatives and ANC became the most important source of information about alcohol. Involving the partner in counseling about alcohol-restriction during pregnancy may be a useful health promotion strategy.

Background: Antenatal care in Sweden involves a visit in pregnancy week 6-7 for counseling about lifestyle issues, including alcohol. The aim of this study was to investigate alcohol consumption among partners of pregnant women, their motives for changing drinking patterns when becoming a parent and their perceptions of the midwife’s counseling about alcohol.

Method: The study was conducted at 30 antenatal care centers across Sweden in 2009 - 2010. All partners who accompanied a pregnant women in pregnancy week >17 were asked to participate. The questionnaire included questions on alcohol consumption.

Results: Questionnaires from 444 partners were analyzed. Most, 95 %, of the partners reported alcohol consumption before pregnancy; 18% were binge drinking (6 standard drinks or more per occasion, each drink containing 12 grams of pure alcohol) at least once every month during the last year. More than half, 58 %, of all partners had decreased their alcohol consumption following pregnancy recognition and a higher proportion of binge drinkers decreased their consumption compared to non-frequent binge drinkers (p=0.025). Their motives varied; the pregnancy itself, fewer social gatherings (potentially involving alcohol consumption) and a sense of responsibility for the pregnant partner were reported. Of the partners, 37 % reported support for decreased drinking from others (pregnant partner, parents, friend or workmates). Further, most partners appreciated the midwife’s counseling on alcohol. Conclusion: A majority of partners decreased their alcohol consumption in transition to parenthood, which also appears to be a crucial time for changing alcohol-drinking patterns. The partners with higher AUDIT-C scores reported more support for decreased drinking. Most partners appreciated the midwife´s talk about alcohol and pregnancy and those who filled out AUDIT in early pregnancy reported that the counseling was more engaging. During pregnancy it is possible to detect partners with high alcohol consumption, and promote interventions for decreased drinking, also for the partners. Written information addressing alcohol use and directed to partners is needed.